Experts bring end-of-life issues, faith to forefront

by Juan Guajardo

North Texas Catholic

September 28, 2017

Rev. Tad Pacholczyk conducts a presentation titled "Making Morally Sound Medical Decisions" during the Do No Harm Conference: Preparing for the End of Life, Saturday, Sept. 23, 2017 at the University of Dallas in Irving. (NTC Photo/Ben Torres)

IRVING — Palliative care, hospice, life expectancy, and death aren’t typically go-to subjects when gathered around the coffee table. Or anytime.

But perhaps they should be, said Father Tad Pacholczyk during the second “Do No Harm” conference series hosted at the University of Dallas on Saturday.

Planned by the Catholic Medical Association and sponsored by the Respect Life Offices of the Dioceses of Fort Worth and Dallas and other groups, the day-long event aimed to bring the Church’s teachings to pro-life issues “from a scientific and medical perspective.” This year the conference brought experts from around the country to tackle end-of-life topics ranging from hospice and palliative care to advance directives and physician-assisted suicide.

“A lot of issues in our culture nowadays have to do with the end of life, assisted suicide, end of life care, and issues and controversies surrounding that,” planning committee member Dr. Cesar Termulo said. “So we thought this was important to cover.”

In his talk, “Care and Treatment Decisions for Patients at the End of Life,” Fr. Pacholczyk, the director of education at the National Catholic Bioethics Center, noted how end-of-life circumstances often dictate the need for ethical, informed, and moral decision making.

The well-known priest, a bioethics expert who holds a Ph.D. in neuroscience, said that while there’s nothing wrong with medicine hunting for the slimmest possibility of surviving a terminal illness or extending a life, it shouldn’t be obsessed with it either for fear of leaving terminally ill patients and their families unprepared for the more probable outcome: death.

“Raging against death can easily become the default position of doctors, nurses, healthcare professionals, and of patients, as well,” he explained to a group of approximately 160 doctors, nurses, counselors, psychiatrists, and medical professionals in attendance. “We need to focus our energy sometimes on preparing for death.”

Referring to the United States Conference of Catholic Bishops’ Ethical and Religious Directives for Catholic Health Care Services, he said end-of-life care should aim to give a person a dignified, comfortable, and natural death. By familiarizing themselves with those directives, families can equip themselves with the Church’s teaching and guidance for when those difficult end-of-life situations invariably arise.

In their document, the bishops state the “truth that life is a precious gift from God” and that “we’re not the owners of our lives and, hence, do not have absolute power over life. We have a duty to preserve our life and to use it for the glory of God, but the duty to preserve life is not absolute.”

Rev. Tad Pacholczyk (NTC photo/Ben Torres)

So if a life-prolonging medical procedure is “insufficiently beneficial or excessively burdensome,” we may reject it, Fr. Pacholczyk explained.

But since “we must be good stewards of this incredible gift of life we received,” he continued, euthanasia or assisted suicide is never a morally acceptable option.

Furthermore, due diligence and taking one’s time to get as much information as possible is necessary in end-of-life situations that seem more gray than black and white.

“This stuff’s not easy on first glance,” Fr. Pacholczyk said. “You’ve got to consult with some experts. You’ve got to have some input from others, maybe from some clergy. You’ve got to spend some time on this, and if you do that and bring it to prayer, the gray shrinks to a line. And you see where that line is between right and wrong and then you end up choosing in a good way for your mom or dad — or whoever it is who is dying.”

If we’re generous in that due-diligence, “we’ll definitely find that clarity because remember the Lord God does not leave us in some kind of a vacuum in these hugely important moments of our lives where our loved ones, or we ourselves, are dying.”

When making moral end-of-life decisions, the distinction between proportionate and disproportionate means is critical, he continued. Context like age, reasonable chance of success, risks and side effects, physical and emotional state of the sick person, and expense are factors in determining whether an intervention or surgery is proportionate, and therefore necessary, or disproportionate and therefore optional.

“If something is proportionate or ordinary we say it is required, you need to do this to be a good steward,” he said. “On the other hand, if something is disproportionate, or extraordinary, it’s optional. And please understand what that means when we say it’s optional. When you say, ‘I am not doing that surgery because I believe it is disproportionate’… you do not commit any sin. It’s very important to be clear on that.”

Sr. Suzanne Gross, FSE, conducts a presentation titled "Palliative Care and Pain Management" during the Do No Harm Conference: Preparing for the End of Life, Saturday, Sept. 23, 2017 at the University of Dallas in Irving. (NTC photo/Ben Torres)

Sister Suzanne Gross, FSE, continued the end-of-life discussion by explaining distinctions and similarities between palliative care and hospice care.

Drawing from her experience as the long-time administrator of her religious order’s hospice care facility in Connecticut, Sr. Suzanne pointed out that unlike hospice care, which is administered during a patient’s final six months to live, palliative care can be provided at any stage of a serious or chronic illness to alleviate pain.

With palliative care, not only does a patient receive care and medications to ease pain related to their diagnosis, but at the same time can receive therapies that are intended to heal or prolong life (like chemotherapy or dialysis). Meanwhile, most hospice programs focus on relieving pain and providing comfort, helping patients get the most quality out of what time they have left.

Both hospice and palliative care providers, especially Christian or Catholic ones, are also called to help the family and patient cope with spiritual and emotional pain during the illness, she said.

“It’s not only the patient we’re there to serve,” Sr. Suzanne reminded attendees. “We also need to work with the family and be patient with them.”

When it comes to relieving pain, whether in a palliative or hospice role, people oftentimes have questions and fears about side effects, she said. But when administered properly and ethically, medications should not subdue patients into unconsciousness “without a compelling reason,” she clarified. And while some pain medications can indirectly shorten a person’s life due to large doses needed for great pain, the intent is never to “hasten or cause death.” It’s a balancing act requiring close communication between the care provider, patient, and loved ones.

Third-year medical student Sarah Doucette appreciated learning about the Catholic viewpoint on end-of-life issues, especially since that’s something not often shared in the secular medical arena.

“It’s really nice to hear people who think like us make logical arguments and give data supporting those stances so that we can [someday] use that as physicians,” she said.

IRVING — Palliative care, hospice, life expectancy, and death aren’t typically go-to subjects when gathered around the coffee table. Or anytime.